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Kansas was one of just three states that saw their rates of people without health insurance go up since last year, according to a new survey.

And, if the poll results are accurate, Kansas was the one whose rates went up the most.

The data, collected as part of the Gallup-Healthways Well-Being Index, show that the uninsured population in Kansas rose from 12.5 percent in 2013 to 17.6 percent by midyear 2014 — a whopping increase of 5.1 percentage points.

Even Kansas Insurance Commissioner Sandy Praeger confesses she’s surprised, although she says there may be several possible explanations for the data.

One, she says, is that the state’s own estimate of a 12 percent uninsured rate was off the mark because, before Obamacare kicked in, uninsured people inaccurately reported being insured.

“We’ve had a woodwork effect in Kansas of more people, even under our stingy Medicaid rules, applying for Medicaid under the old rules who didn’t apply before, just because there’s greater discussion around insurance now,” she says.

“So it may be that people are more aware of what it means to have insurance and are less likely to self-report that they have insurance when they are in fact uninsured. And it may be the way the pollsters asked them the question that made them more likely, I don’t know.”

Like Praeger, Cindy Samuelson, a vice president of the Kansas Hospital Association, says she’s baffled by the sharp rise in uninsured Kansans – although she says Kansas’ failure to expand Medicaid – called KanCare in Kansas – was certainly a factor.

“I think this justifies what we’re trying to do and looking to expand KanCare,” she says, referring to efforts by the Kansas Hospital Association to expand Medicaid eligibility in Kansas.

Whatever the explanation for the Gallup data, it clearly shows that states that opted to expand Medicaid and set up their own health insurance exchanges under the Affordable Care Act showed the biggest drops in their uninsured rates. Kansas chose to do neither.

Praeger, a moderate Republican who bucked the party establishment by supporting the federal health reform law, says those results are not surprising.

“The consistent message there is that states that did their own exchange made it easier for people to sign up and states that did Medicaid expansion saw the greatest decrease in uninsured members,” she says.

As Gallup previously reported, the states that took both those steps had lower uninsured rates to begin with. But the gap has since widened.

States that expanded Medicaid eligibility and set up their own exchanges or partnered with the government to run exchanges experienced an overall drop of 4 percentage points in their uninsured rates. States that took neither step or only one experienced a drop of 2.2 points.

Missouri, which, like Kansas, did not set up its own exchange or expand Medicaid, saw its uninsured rate drop – but just barely. It went from 15.2 percent in 2013 to 15.1 percent by midyear 2014.

The poll shows that the Affordable Care Act, or Obamacare, has largely succeeded in accomplishing one of its main aims: reducing the number of people without health insurance.

Nationwide, the uninsured rate peaked at 18 percent in the three months before the healthcare exchanges opened last October, according to the poll. The rate has since declined to 13.4 percent, “the lowest quarterly rate in more than six years of Gallup-Healthways Well-Being Index trending,” Gallup reported.

Topping the list of states with the sharpest reductions were Arkansas and Kentucky. Arkansas saw its uninsured rate fall from 22.5 percent to 12.4 percent; Kentucky saw its rate fall from 20.4 percent to 11.9. Both states expanded Medicaid — Arkansas via a “private option” plan — and both set up exchanges either on their own or in partnership with the federal government.

Even the two states besides Kansas that saw their uninsured rates rise — Virginia and Iowa — only saw them go up by statistically insignificant amounts. Virginia saw an uptick of 0.1 percentage points and Iowa 0.6 points.

The poll was based on respondents’ reports on their insurance status, based on the question, “Do you have health insurance coverage?” The 2013 margin of sampling error ranged from plus or minus 1 to 2 percentage points for most states to plus or minus 3.5 points for smaller states. For the midyear 2014 results, the error range was as high as plus or minus 5 points for the smallest states.

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